Tamoxifen retinopathy. A clinicopathologic report.

A 57-year-old woman with metastatic breast carcinoma treated by surgery and high-dosage tamoxifen chemotherapy developed tamoxifen retinopathy characterized by white superficial refractile retinal lesions primarily in the paramacular area. At postmortem examination, the retinal lesions seen clinically were identified as being 3 to 10 microns in diameter in the macular area, and 30 to 35 microns in diameter in the paramacular area. The lesions were confined to the nerve fiber layer and inner plexiform layer and stained positive with stains for glycosaminoglycans. Electron microscopic examination revealed that the smaller lesions were intracellular and the larger lesions extracellular. The lesions were composed of randomly oriented branching electron dense 6-nm filaments accompanied by occasional electron dense coated vesicles measuring 60 to 70 nn in diameter. The lesions appeared to be occurring in axons and seemed to represent products of axonal degeneration.